This application is a request for a Scientist Development Award for Clinicians (K20) from the National Institute on Drug Abuse (NIDA). My commitment to a research career combined with my training in Infectious Disease, Public Health, HIV, and my interest in studying drug abuse make the K20 from NIDA an ideal funding mechanism for me at this stage in my career. It granted this award, I expect to learn how to independently design, implement and analyze epidemiologic and interventional studies in the overlapping field of drug abuse and infectious diseases. I plan to work closely with two accomplished preceptors, Dr. David Vlahov, from the Johns Hopkins University School of Hygiene and Public Health, and Dr. Robert Swift, from Brown University, both of whom have expertise in the epidemiology of substance abuse and treatment. I will participate in the Fellowship Program and other activities at the Brown University Center for Alcohol and Addiction Studies, and in activities at the Johns Hopkins School of Hygiene and Public Health and attend two national meetings involving substance abuse. The proposed research project will study utilization and outcome of injection drug-using women, with respect to participation in a Needle Exchange Program. Women with active injection drug use will be recruited from the only prison in Rhode Island, the Adult Correctional Institution (ACI), where I have been working part-time. Women will also be recruited from the ongoing longitudinal HIV Epidemiology Research Study (HERS), which follows 225 HIV positive and 115 HIV negative women at The Miriam and Pawtucket Memorial Hospitals. Three hundred women with active injection drug use, including participants and non-participants in needle exchange, will be followed at six-month intervals for one year to address the following specific aims: 1) To compare risk behavior profiles between Program participants and non-participants, including frequency of injection, needle sharing, source of obtaining needles, episodes of cessation, and participation in drug abuse treatment; 2) To determine the utilization and the obstacles to participation in needle exchange, particularly those which are unique to women; 3) To compare medical outcomes between Program participants and non-participants including incidence of HIV, HTLV II, and hepatitis B and C, and episodes of other injection-related complications including abscesses, cellulitis and endocarditis. Baseline and two six-month follow-up interviews and phlebotomy will be performed.